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CC BY 4.0 · TH Open
DOI: 10.1055/a-2719-9061
Original Article

National early warning score for predicting clinical outcome of acute pulmonary embolism in intermediate high risk patients

Authors

  • Audrey Overgaauw

    1   Internal medicine, VU Medisch Centrum, Amsterdam, Netherlands (Ringgold ID: RIN1209)

  • Esther Nossent

    2   Department of Pulmonary Medicine, VU Medical Center Institute for Cardiovascular Research, Amsterdam, Netherlands (Ringgold ID: RIN171890)

  • Lilian Meijboom

    3   Department of Radiology and Nuclear Medicine, VU Medisch Centrum, Amsterdam, Netherlands (Ringgold ID: RIN1209)

  • Erik Serne

    4   Department of Internal Medicine, VU Medisch Centrum, Amsterdam, Netherlands (Ringgold ID: RIN1209)

  • Yvo Smulders

    4   Department of Internal Medicine, VU Medisch Centrum, Amsterdam, Netherlands (Ringgold ID: RIN1209)

  • Prabath Nanayakkara

    5   Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands (Ringgold ID: RIN1209)

  • Harm Jan Bogaard

    2   Department of Pulmonary Medicine, VU Medical Center Institute for Cardiovascular Research, Amsterdam, Netherlands (Ringgold ID: RIN171890)

  • Pieter Roel Tuinman

    6   Intensive care medicine, VU Medisch Centrum, Amsterdam, Netherlands (Ringgold ID: RIN1209)

  • Erik Klok

    7   Internal medicine, vascular medicine, LUMC, Leiden, Netherlands (Ringgold ID: RIN4501)
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Background: Although the European Society of Cardiology (ESC) predicts mortality in acute pulmonary embolism (PE) it may overtriage the level of clinical monitoring needed. While the National Early Warning Score (NEWS) is used to triage level of care in many diseases, it is rarely reported in PE literature. Methods: In this retrospective, single centre, observational cohort study of consecutive adults with acute PE, between 2017-2020, we aim to assess the association between NEWS scores and the risk of hemodynamic (HD) deterioration or PE-related death in intermediate-high risk PE patients. The National Early Warning Score (NEWS) at admission and after 24hours were determined. A baseline NEWS of ≥5 or the maximum score of a single parameter were considered an indication of high risk of our primary outcome (hemodynamic deterioration and/or PE-related mortality). Results: ESC classified 99 of 318 patients with PE intermediate-high risk, 8 patients (8%) met the primary outcome. 52 (52%) patients had an elevated NEWS and 7 of these met the primary outcome (13%), while only 1 patient with a non-elevated NEWS (2.0%) met the primary outcome (Negative predictive value of 98% (95% CI 90-98%)). Sensitivity of elevated NEWS in patients with intermediate-high risk patients was 88% (95% CI 74-90%) and the specificity was 51% (95% CI 41-61%). Conclusions: Using NEWS in intermediate high risk, acute PE patients may improve accuracy in identifying patients with a higher risk of adverse outcomes and may guide the decision to monitor a patient in a high-care department, especially in patients with intermediate high risk PE.



Publikationsverlauf

Eingereicht: 04. Juli 2024

Angenommen nach Revision: 06. Oktober 2025

Accepted Manuscript online:
13. Oktober 2025

© . The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Audrey Overgaauw, Esther Nossent, Lilian Meijboom, Erik Serne, Yvo Smulders, Prabath Nanayakkara, Harm Jan Bogaard, Pieter Roel Tuinman, Erik Klok. National early warning score for predicting clinical outcome of acute pulmonary embolism in intermediate high risk patients. TH Open ; 0: a27199061.
DOI: 10.1055/a-2719-9061